Intoxicated Lady: A Case of Poisoning

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A 65 year old female was brought to the Palghar hospital by the police. She was alone with no relatives. She appeared intoxicated and was flaccid and weak. Apparently she was traveling by train when this happened and was taken to the police station by co-passengers. The police realising that she needed treatment, brought her to our homeopathic hospital.

When we saw her in the ER, our observations noted down were: she appeared to be in an inebriated state, unable to stand on her own. She had an altered sensorium with flaccid, hypotonic muscles. She kept talking in Hindi in what appeared as repetitive talk.

From our observations of her dress and demeanor, we confirmed that this lady was of traditional and local (Maharashtrian) tribal background. This meant that she grew up speaking and exposed to Marathi, which is the language of Maharashtrian tribals. She could not have been adequately exposed to the Hindi language, enough to talk it as fluently as she was right now.

With the help of the police we pieced together the story that she had been traveling by train and someone had offered her “Prasad” (an eatable that has been offered to the Gods during a Puja). After that she had no memory of what happened. She had been unconscious for some time and when she awoke, she found that she had been robbed.

CNS: Responding to oral commands Not oriented to person, time and place Loss of memory for the episode Delirious, Repetitive talk, Talking in the Hindi language Suspicion of being of poisoned Hypotonic, Flaccidity. Reflexes – Normal Pupils- dilated

Discussion:

The first important step is managing a case of poisoning is detecting which is the poison. A thorough knowledge of the commonly used poisons, their effects and the various motives for using them is part of the study of Forensic Medicine for any qualified medical graduate. This has to be re-studied when being trained to handle hospital emmergencies that arrive in the ER.

The poison used here was detected to be DHATURA (also: Datura–ed.).. Here is some information about Dhatura.

It is most commonly used for poisoning locally as it grows in waste places all over the India. The alkaloid of Dhatura powerfully stimulates the higher centers of the brain and exercises a paralyzing action on various nerves. Initially there is a stimulation of various centers in the brain is followed by depression.

What helped us decide on Dhatura is the following information about its common use: It is a ROAD POISON. It grows on its own so easily accessible and cheap.It can be mixed with food and drink as it does not change the odor or taste. It is used mainly to dope travelers and people at pilgrimage sites for the purpose of robbery(and not suicide or homicide). The patient is generally found in a police station.

Homoepathic Analysis at this point:

The two characteristic symptoms observed:

Speaking in a foreign language

Ailments from Dhatura Poisoning

The pathogenesis that could be observed was that the brain – ie – the sensorium and nerves were affected. She was intoxicated. There was a hyper-excitability of the sensorium, while she remained paralyzed peripherally. The hyper excitability was expressed in her loquacity and repetitive talk. Peripheral paralysis was evident in her hypotonia and flaccidity on CNS examination.

She recieved one single dose of Stramonium 1M with a plan to repeat cautiously in case improvement stopped.

Patient as a person:

Once she began to improve on the acute simillimum, we were able to elicit more details about her.

She explained that she had a strong belief in God since childhood, inculcated by mother who often said “God will help you in your life”. Her mother used to tell her “you will find money if you pray at a desired spot”. This was experienced by the patient on several occasions. Hence, she developed a strong belief to the point of superstition, in God. She always used prayers as a means to solve all problems in life. She would develop very easily an attachment and sentimentality toward persons.

Her fears included a fear of crossing streets. Her sleep would be disturbed due to anxiety about trifles.

Follow up:

Within 90 minutes of the dose there was a remarkable improvement! Her alertness and sensorium improved and her flaccidity had improved. She was still speaking intermittently in Hindi (foreign language).

4 hours after the dose, she was completely alert and asymptomatic. She was conscious and well oriented in space and time. On clinical examination her fl acidity had improved.

Once she was much better, the analysis of her chronic case showed that she needed Calc Carb as constitutional remedy. She was now given a dose of Calc Carb 200C.

The homeopathic simillimum is often indicated in Poisonings as well, provided we are able to detect the possible cause of the poisoning, understand the pathogenesis of the poisoning, give the needed ancillary treatment and management required, and observe accurately the homeopathic charactersitics of the individual expression of the poisoning.

The choice of remedy in a group of remedies is made while understanding the pathological effect of the poison, which is easily available in text-books of forensic medicine. This is furthur helped by a proper study of the pathogenesis of the indicated homeopathic remedies.